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Delayed pneumothorax after central venous access: a potential hazard
J G Tyburski1, A L Joseph, G A Thomas
1Department of Surgery, Wayne State University, Detroit, Michigan.
The American Surgeon
|September 1, 1993
Summary
Delayed pneumothorax after central venous catheter placement is a rare but serious complication. Immediate chest X-rays may appear normal, necessitating a high index of suspicion for timely diagnosis and treatment, especially in ventilated patients.
Area of Science:
- Medical Procedures
- Pulmonary Medicine
- Patient Safety
Background:
- Percutaneous central venous catheterization is a frequent procedure in surgical patients.
- Pneumothorax is the most common major complication associated with central venous catheter placement.
- Routine assessment involves chest X-ray within 2 hours post-insertion.
Purpose of the Study:
- To report on cases of delayed pneumothorax following central venous catheterization.
- To review the literature on this specific complication.
- To emphasize the importance of recognizing and managing delayed pneumothorax.
Main Methods:
- Retrospective identification of five patients with delayed pneumothorax.
- Review of English literature for similar cases.
- Analysis of clinical presentation and outcomes.
Main Results:
- Five cases of delayed pneumothorax were identified over a 6-month period.
- All initial post-insertion chest X-rays were normal.
- Delayed pneumothorax was life-threatening in one patient on positive pressure ventilation.
- A total of 18 cases were found in the literature.
Conclusions:
- Delayed pneumothorax, though rare, is a potentially fatal complication of central venous access.
- A high index of suspicion is crucial for diagnosis, particularly in patients on positive pressure ventilation.
- Prompt diagnosis and treatment are essential for managing this reversible condition.